目的 比较体外受精-胚胎移植(IVF-ET)中应用不同方案小剂量促性腺激素释放激素激动剂(GnRH-a)降调节,对临床结局的影响.方法 回顾性分析本中心行控制性卵巢刺激降调节方案的1,478个周期,根据GnRH-a用药方案不同分成2组,A组(nA＝895):常规方案组于黄体中期给予短效GnRH-a 0.1 mg/d,14 d后减至半量,使用至人绒毛膜促性腺激素(hCG)注射日；B组(nB＝583):新方案组于黄体中期给予短效GnRH-a 0.1 mg/d,10 d后减至半量,使用至hCG注射日.根据使用GnRH-a 14 d后是否达到降调标准又分为两组:a组:正常启动组(na＝1,189,其中nAs＝720,nBa ＝469);b组:延迟启动组(nb＝289,其中nAb＝175,nBb＝ 114).所有降调达标准后立即启动Gn,若未达标准则继续使用GnRH-a直至达标后再启动Gn.比较各组间实验室及临床结局之间的差异.结果 (1)各组间相比,以常规方案延迟启动组(Ab组)Gn使用量最多,新方案正常启动组(Ba组)使用量最少(P＜0.05)；(2)各组间平均获卵数、2PN受精率、2PN卵裂率、总优质胚胎率、中重度卵巢过度刺激综合征率无差异(P＞0.05).结论 (1)在保证降调达标准前提下,适当降低GnRH-a剂量,可在不影响临床妊娠结局的情况下减少Gn使用天数和总量；2.降调未达标时继续应用GnRH-a至达标后,仅增加Gn使用量而不会影响临床结局.%Objective: To investigate the effect of duration of pituitary down-regulation on the outcomes of in vitro fertilization-embryo transfer (IVF-ET) after using two treatment regimens of gonadotropin releasing hormone agonist (GnRH-a).Methods: A retrospective analysis was performed on a total of 1,478 cycles. They were divided into two groups according to the different treatment regimen of GnRH-a, group A(n = 895):short acting GnRH-a (0. 1 mg/d) was administrated daily for 14 days during the mid-luteal phase of their menstrual cycles, then reduced GnRH-a dose to 0. 05 mg/d till hCG administration; group B(n=583) : short acting GnRH-a (0. 1 mg/d) was given daily for 10 days during the mid-luteal phase, then reduced to 0. 05 mg/d till hCG administration. The patients were given gonadotropin (Gn) when they reached the down regulation criterion after 14 days, otherwise continued to give GnRH-a. Then they were divided into two groups according to whether the successful pituitary down-regulation was achieved after 14 days used GnRH-a: group a: GnRH-a was used for 14 days (n= 1,189;including nAa = 720,nBa, = 469); group b; GnRH-a wasused for more than 14 days (n = 289;including nAb = 175,nBb = 114).Results: 1. The dosage of Gn used in the group Ab was the smallest, and the largest was in group Ba (P<0. 05). 2. There were no significant differences in average number of retrieved oocytes, 2PN fertilization rate, 2PN cleavage rate, total quality embryo rate, moderate and severe ovarian hyperstimulation syndrome among the groups (P>0. 05).Conclusion: 1. Under the prerequisite of reaching down regulation criterion, GnRH-a dosage should be properly reduced; and on the premise that pregnancy outcome could not be affected, the amount and duration of Gn could be limited. 2. GnRH-a should be used more days than normal if the down regulation criterion had not been achieved, and the pregnancy outcome would not be affected only by increasing the dosage of Gn.
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